The Health and Disability Working Group at the Boston University School of Public Health was chosen to lead the multisite evaluation, which occurred under the project Evaluation Center on HIV and Oral Health (ECHO). The initiative evaluation center Website can be accessed at: http://echo.hdwg.org/.

The overall goal of the initiative was to expand access to comprehensive oral health care provided in accordance with professional standards to improve oral health outcomes of PLWHA.

Other important objectives of the SPNS Oral Health Initiative included integrating medical and dental care, and sustaining programs beyond the life of the grant.

Initiative outcomes

– 2,500 PLWHA who had been out of oral health care for 1 year or more were served

– 14,500 visits occurred

– 26,000 dental procedures were performed.

SLIDE 3: Patient Testimonial to the Benefits of SPNS Oral Health Care

“[Oral health care has] definitely helped me. Because when [the Harbor Health dental staff] did the top teeth, I guess I had an infection in there probably for about a year and a half. So, my T cells once this was all done jumped 100 points. So yeah, and I feel a lot better. Now that I don’t have any pain, I’ve been in pain for like, I don’t know 8 years. I was used to it, you know.”

Slide 4: Changing Lives Through Good Oral Health Video

After the video, the Trainer should lead the group in discussion of reactions to the video.

– What was your overall impression of the video?

Is there anything you learned about the impact of oral health on PLWHA that you did not know before watching this video?

Slide 5: Organizationa l Models Studied

Each demonstration site had to determine which organizational model(s) they would use, how they would recruit and train clinical staff, and how they would recruit and retain patients into care.

Six organizational models were used across the sites (many utilized various combinations):

1. Increasing services at their existing clinics

2. Building satellite clinics

3. Collaborating with clinics in dental hygiene schools or community colleges

4. Fee-for-service dental reimbursement with contracted providers

5. Leasing space at existing private offices/clinics, and

6. Purchasing mobile dental units.

HANDOUT

The Trainer should distribute the table of organizational model pros and cons shown below as a handout so that participants can take notes on the models during the following discussion of slides. Please read the pros and cons within the table.

OVERVIEW OF THE SIX SPNS ORGANIZATIONAL MODELS STUDIED

Model

Grantee

Pros

Cons/Caveats

Increasing services at their existing clinics

Harbor Health

Most expedient model

Does not necessarily enable clinic to expand oral health care access to new geographic areas or populations

Building satellite clinics

AIDS Care Group

AIDS Resource Center Wisconsin

Special Health Resources for Texas

Community Health Center, Inc

Tenderloin Health Center

Reduces travel time for some patients, often reducing a huge barrier to care

Enables greater patient enrollment

Improves likelihood of program sustainability

Can be costly

Can take a lot of time to establish, including navigation of regulations and completion of construction

Collaborating with clinics in dental hygiene schools or community colleges

HIV Alliance*

High-quality oral health care for PLWHA in a mixed clinic setting

Improved training in care of PLWHA and reduced perception of HIV stigma on part of students

Enhanced clinical space and equipment

Faculty supervision and training

Requires careful coordination and flexibility

Ensure that expectations for participating organizations in partnership are clearly and formally spelled out and agreed upon prior to beginning collaboration

Fee-forservice dental reimbursement with contracted providers

AIDS Resource Center Wisconsin

Reduced travel time for patients

More cost-effective than establishing a formal satellite clinic

Important to ensure that dentists recruited are culturally and clinically competent to serve PLWHA

Funding options for fee-for-service varies by State and may be more or less attractive to providers as a result

Leasing space at existing private offices/clinics

Center for Comprehensive Care

Increased access to care for patients

Less resource-intensive than building a satellite clinic

Provision of care in private clinics that are non-HIV-affiliated may reduce risk of stigma for patients

Leased office locations may not qualify as Medicaid-certified providers, limiting ability to bill for dental services in some States

Important to ensure that patient caseload is manageable so that patients can be seen at regular intervals for follow-up care to improve retention and clinical outcomes

Purchasing mobile dental units

Sandhills Medical Center

University of Miami

Louisiana State University

Montefiore Medical Center

Enables provision of care to patients isolated by geography or with challenges traveling to dental services

Ability to serve a high volume of patients

Expensive to purchase**

Expensive and time-intensive to maintain both the dental equipment and the unit itself***

Requires research into unique State regulations, infection control procedures, town and county parking ordinances, medical record access and storage, and scheduling and staffing

Requires referral of clients to other nonmobile clinics for many dental services, including most x-rays

Patient confidentiality may be a concern when using electronic medical records through wireless system

Difficult to navigate roads with sensitive dental equipment on board because measures used to hold equipment stable were often insufficient

*While HIV Alliance was the only grantee to use relationship with dental program as their program model, several other grantees established formal or informal relationships with dental professional schools.

**Mobile dental units used by grantees ranged from $144,000 for a one-chair unit to $330,000 for two-chair unit.